Individual
RYAN ANTHONY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1200 KENWOOD AVE, DULUTH, MN 55811-4199
(218) 723-5906
Mailing address
1615 DIVISION ST, NEW LONDON, WI 54961-2303
(920) 277-4119
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/16/2019
Last updated
12/16/2019
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